Permanent Identifier

Abstract

Too often, patients in low and middle
income
countries
receive
inadequate
quality
healthcare. Technical capacity constraints -
insufficient
availability
of competent
health professionals, medicines and other essential
inputs
-
are
often seen as the
cause. Whilst undoubtedly important, these
constraints
cannot
fully
explain poorly
delivered health services. This thesis explores
how
supply-side
incentives
also
influence the quality of healthcare doctors deliver to
patients.
It
uses the
analytics of
the principal-agent model as the starting point
for illustrating the impact
of
different
incentives on medical effort, and through this
effort,
the
quality of
healthcare.
Insights and testable hypotheses emerging
from this
conceptual
approach
are then
evaluated through empirical studies
of
doctors
working
in 30
districts in the
Philippines, using a variety of econometric methods.
Data came from both primary and secondary
sources.
A first
study explored the
relationship between empirical measures
of
medical
effort
and
the technical
quality
of healthcare. A second study analysed
how
various
financial
and
non-financial
incentives affect the amount of medical
effort
exerted
by
doctors
on
public
hospital
inpatients. A third study addressed
the
phenomenon
of physician ownership
of
private pharmacies, and whether this
has
any
adverse
impacts
on patients.
Results showed that whilst the relationship
between
medical
effort
and quality
is
not
straightforward, low effort typically results
in lower
quality
care.
Subsequent
results
illustrated how supply-side incentives can
lead to
public
hospital
patients
with equal
health need being treated unequally;
and
pharmacy-owning
physicians unduly
influencing a patient's use and expenditure
in
pharmacies.
Suggested
policy
reforms
are based on reshaping the incentive structure
within
which
doctors
operate,
including reform of provider payment mechanisms
and
patient charges;
improved
monitoring and regulation; and policies to
encourage
greater
use of
generic
drugs.